AccountId: 011433970860
ContactId: 6d9afb60-3003-45f9-82d6-378adf3f9c3e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352359 ms
Total Talk Time (AGENT): 98611 ms
Total Talk Time (CUSTOMER): 144166 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/6d9afb60-3003-45f9-82d6-378adf3f9c3e_20250522T18:43_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office looking for a general claim status.
[AGENT][NEUTRAL] OK, I can help you with that, [PII], claim status. Um, do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 021 06897 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And what's the patient name and date of birth?
[CUSTOMER][NEUTRAL] First name spelled as [PII] Last name spelled as [PII]
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] Data service is [PII]. Bill amount is $268 even.
[AGENT][NEUTRAL] OK, it looks like this policy terminated in [PII]. Let me see if there is a more recent policy.
[CUSTOMER][NEUTRAL] Sunday
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm checking. Hold on one moment.
[CUSTOMER][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do this.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The [PII]?
[CUSTOMER][NEUTRAL] Yes, data services [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, looks like the the claim was received on.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Claim received [PII], processed [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[AGENT][NEUTRAL] Insurance.
[CUSTOMER][NEUTRAL] Claim was denied, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, please give me a reason.
[AGENT][NEUTRAL] Office visits are not covered under the policy, and insurers' primary EOB insured's primary insurance provided full benefits on the second line items.
[CUSTOMER][NEUTRAL] OK. Insurance need them, right?
[AGENT][NEGATIVE] The office visits are not covered for line item 1. It's not covered under the policy. The second line item, primary insurance paid in full.
[AGENT][NEUTRAL] Therefore, there's nothing left for us to pay.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The second, uh.
[CUSTOMER][NEUTRAL] Second line denial is uh primary OB.
[AGENT][NEUTRAL] No, the primary insurance paid in full, therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] that's
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Thank you. Can you fax EOB copy of EOB?
[AGENT][NEUTRAL] Sure. What's your fax number?
[CUSTOMER][POSITIVE] Thank you, I will give you fax numbers.
[CUSTOMER][NEUTRAL] 305
[CUSTOMER][NEUTRAL] 928.
[CUSTOMER][NEUTRAL] 6742
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And attention my name [PII].
[AGENT][POSITIVE] OK, I'll get that faxed over. It just takes a few minutes. Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Uh, no thank you. How much time would take fix?
[AGENT][NEUTRAL] A few minutes.
[AGENT][NEUTRAL] Just like 2 minutes.
[CUSTOMER][NEUTRAL] OK. Uh, OK, thank you. Uh, can you give me a call reference?
[AGENT][NEUTRAL] All reference is my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Your name spelled as?
[AGENT][NEUTRAL] It's spelled as [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] And do it. Thank you, um, assisting me. Have a nice day bye bye.
[AGENT][POSITIVE] OK, thank you for calling APL you as well. Bye bye.